opthalmology

Question 1

Chronic progressive external ophthalmoplegia

Answer 1

mitochondrial disorder

poor eye movements and bilateral ptosis

Question 2

sudden loss of vision with inability to speak. symptoms resolved in 15 minutes.
cause
ix.
mx.

Answer 2

TIA - amaurosis fugax

Ix. no abnormalities on opthalmoscope
300mg aspirin, review in TIA clinic in 24hours

Question 3

flashes, floaters, permanent curtain like loss of vision

Answer 3

retinal detachment

Question 4

unilateral severe headache, scalp tenderness, jaw claudication, unilateral reduced visual acuity

pmh. polymyalgia rheumatica

diagnosis,
investigations
mx.

Answer 4

giant cell arteritis - large vessel vasculitis
aka. arteritic ischaemic optic neuropathy

affects arteries supplying optic nerve

raised ESR
temporal artery biopsy within 2 weeks

mx. high dose IV methylprednisolone

Question 5

eye punch - fracture which bones?

Answer 5

floor of orbit (maxillary bone) is most likely to be fracture
blow out fracture
infraorbital nerve can be damaged – numb below eye

Question 6

periorbital vs orbital cellulitis

Answer 6

periorbital cellulitis (preseptal cellulitis) - no pain on movements, no diplopia, no visual impairments

orbital cellulitis does + proptosis

Question 7

periorbital cellulitis

Answer 7

red, swollen eye, fever, erythema, oedema
infection for skin or local infections following lacerations

all patients should have CT of the orbit

Question 8

anterior uveitis

Answer 8

HLA-B27
ank spond
reactive arthritis
IBD
behcet's
sarcoidosis